Health care access in the Netherlands: A true story
The Dutch health care system has undergone a shift toward a universal basic health insurance scheme for the entire population, but unlike most universal systems, the system is carried out by multiple private health insurers. Although based on the principles of competition - allowing providers and insurers to compete for consumers - it is also highly regulated to ensure the allocation of essential care according to need. The Dutch system is an interesting marriage of tensions in that while it moved to expand insurance to all citizens, it simultaneously introduced a much greater role for the private sector in terms of relying on competing private for-profit health insurers. Although liberalizing and privatizing health care may be justifiable for economic and financial reasons (cost reduction, efficiency improvement, innovation), there are serious concerns about whether a system of regulated competition and emerging private health arrangements respects the basic human right of equal access to health care services. From a human rights perspective, combining competition and private initiatives in several health care markets with restrictive measures inspired by social values is an extremely difficult exercise. For example, as I discuss in more detail later in the chapter, several market-driven policies have undermined the right to equal access (e.g., preferential treatment arrangements, voluntary deductibles, discounts for group insurance schemes).